Association of Acupuncture and Auricular Acupressure With the Improvement of Sleep Disturbances in Cancer Survivors: A Systematic Review and Meta-Analysis

Acupuncture and auricular acupressure in the treatment of sleep disturbances in cancer patients represent a growing area of medical interest, especially considering that sleep problems affect between 30% and 50% of cancer survivors, a rate nearly three times higher than the general population. These disturbances frequently persist for years after the end of oncologic treatment, significantly impacting patients' quality of life. Traditional treatments, such as hypnotic medications, can cause dependence and unwanted side effects, while cognitive-behavioral therapy, although effective, is not always accessible to all patients. In this context, complementary therapies such as acupuncture and auricular acupressure emerge as potentially valuable alternatives, being considered relatively safe and well accepted by patients.

This study's primary aim was to scientifically evaluate the efficacy and safety of acupuncture and auricular acupressure in the treatment of sleep disturbances in cancer survivors. To this end, the researchers performed a systematic review and meta-analysis, following rigorous scientific research protocols. Eight medical databases were analyzed, four in English and four in Chinese, covering publications from the inception of each database through July 2021. The inclusion criteria were quite specific, focusing only on randomized controlled clinical trials that compared acupuncture or auricular acupressure with sham treatments, medications, behavioral therapy, or usual care.

The methodological quality of each study was assessed using internationally standardized tools, and the data were analyzed statistically to identify consistent patterns of efficacy.

After an initial search that identified 194 potential studies, the researchers selected 13 randomized clinical trials that met the rigorous quality criteria, involving a total of 961 patients from six different countries: United States, China, South Korea, Denmark, Sweden, and Australia. Participants had different types of cancer, with breast cancer being the most prevalent (46% of cases), followed by ovarian, colorectal, and other types. Mean age ranged from 44 to 63 years, with a predominance of female participants. Acupuncture and auricular acupressure treatments varied considerably across studies in terms of points used, frequency of application, and treatment duration.

Surprisingly, the results did not show convincing evidence that acupuncture or auricular acupressure were superior to control treatments in improving sleep disturbances. When compared with sham treatments, the benefits were minimal and not clinically significant. Likewise, there were no statistically relevant differences when compared with waiting list or traditional insomnia medications.

The clinical implications of these findings are complex and require careful interpretation. Although the results did not demonstrate clear efficacy of the studied therapies, this does not necessarily mean that they are useless in the real-world clinical context. The researchers identified that combined treatments, such as acupuncture combined with sleep hygiene education or medications, showed more promising results. This suggests that these complementary therapies may have greater value when integrated into multidisciplinary approaches than when used in isolation.

For health professionals, these results indicate the need for caution when recommending acupuncture or auricular acupressure as standalone treatments for insomnia in cancer patients. However, considering that these therapies showed an excellent safety profile, with only minimal adverse effects reported, they may still have a place as components of a broader therapeutic plan. For patients, it is important to understand that, although these therapies are safe, current scientific evidence does not support expectations of dramatic improvement of insomnia symptoms when used in isolation.

This study has some important limitations that should be considered when interpreting the results. First, the methodological quality of many of the included studies was rated as moderate to low, mainly due to the inherent difficulty of implementing adequate blinding in acupuncture interventions — both patients and therapists generally know when real acupuncture is being applied. Second, there was great variability across studies in terms of techniques used, acupuncture points selected, frequency and duration of treatments, making it difficult to determine whether specific protocols could be more effective. Third, most studies used subjective sleep assessment scales rather than objective measures such as polysomnography, which may have influenced the results.

Finally, the relatively small number of available studies limited the ability to perform more robust statistical analyses. The researchers conclude that larger clinical studies with more rigorous methodology and standardized protocols are needed to definitively clarify the potential role of acupuncture and auricular acupressure in the treatment of sleep disturbances in cancer survivors.